Medical triage system

ABSTRACT

A method of determining a triage disposition for a person includes providing a plurality of triage categories that includes questions grouped into a plurality of tiers ranked according to urgency. Each of the plurality of tiers corresponds to one of a set of triage dispositions. At least a first relevant triage category and a second relevant triage category can be selected from the plurality of triage categories based on information about a medical condition of the person and then accessed. The person can be triaged by (a) identifying from all of the selected relevant triage categories a highest urgency tier that has at least one unasked question; (b) asking the person one of the at least one unasked question of the highest urgency tier; and (c) repeating (a) and (b) for all of the selected triage categories until the triage disposition is determined.

COPYRIGHT NOTICE

A portion of the disclosure of this patent document contains materialwhich is subject to copyright protection. The copyright owner has noobjection to the facsimile reproduction by anyone of the patent documentor the patent disclosure, as it appears in the Patent and TrademarkOffice patent file or records, but otherwise reserves all copyrightrights whatsoever.

BACKGROUND

Originally, medical triage was a process deployed during wartime ordisasters by which a nurse or other medical professional personallyperformed an initial assessment of patients to group them into one ofthree categories: those too ill to benefit from immediate medical care,those well enough to survive without immediate care, and those who couldbenefit from immediate care. In situations in which immediate medicalcare was a scarce resource, triage methodology helped ensure that suchcare would be allocated rationally, for maximum aggregate benefit.

In a broader sense, medical triage is a process for sorting people withmedical complaints into groups based on the likelihood of thembenefiting from particular levels of medical treatment. For example,most hospital emergency rooms utilize some kind of triage methodology todetermine the priority in which patients receive care. The methodologycan also include a decision-making strategy for deciding whether a nurseis able to dispense an adequate level of care or a physician is requiredfor a higher level of care. Much of this is done in person, usingmedical assessments such as blood pressure, pulse, skin color, andgeneral observations of the patient to supplement what the patientdescribes about his or her condition. The staff then applies hospitaltriage rules based on that information to determine treatment priorityand a level of care, typically aiding those with the most seriousconditions first.

Such medical triage systems exist to ensure that an appropriate level ofcare is dispensed to all individuals, by evaluating the significance oftheir self-reported or observed symptoms and matching them with aparticular level of care. Accurate triaging means that the patient'smedical concerns receive a suitable level of medical attention—neithersubstantially more nor substantially less than what he or she needs.

Triage systems can also ensure that the dispensation of care is moreeconomically efficient. In this age of ballooning medical costs, amedical triage system can mean that ultimately pays for the medicalservices (e.g., government, companies or individuals) does not pay foran unnecessary level of treatment. For example, if someone with a minorinjury is accurately triaged, an appropriate level of care can bedetermined, while expensive services, such as ambulance transport andemergency department care, can be avoided, if unnecessary.

Some triage systems are focused on controlling and limiting utilizationof medical services (i.e., gate keeping). These triage systems areoperated by or paid for by insurance companies and/or third partyadministrators responsible for general health care costs. The systemguides callers to medical generalists, rather than to more costlyspecialists, except when a specialist is necessary. These systems willalso direct referrals to in-network (i.e., discounted) medicalproviders, steering callers away from out-of-network (i.e.,non-discounted) providers.

The spread of telecommunications means that some types of medical triagecan be employed by persons who are not on-site with the patient.Advances in triage methods have enabled persons without extensivemedical training to conduct some types of triage, so long as they aretrained in the triage methods. A common form of triage that is conductedtelephonically and by non-medical professionals with specializedtraining is that used by 911 Emergency Medical System (EMS) dispatchingservices. However, these services generally operate under the assumptionthat some emergency medical response will be sent to all callers. Thedispatcher typically determines the level of response (e.g., whetherbasic or advanced life support is dispatched, which ambulance or otherresponder is closest to the caller, and which caller 105 gets prioritywhen there are multiple simultaneous calls). EMS dispatchers alsoprovide pre-arrival instructions, guiding callers in simple life savingtechniques to help stabilize patients until emergency personnel arrive.

Medical providers, including clinic and hospital departments, may alsoutilize a triage service for screening purposes. For example, manyexpectant mothers and parents call obstetricians' and pediatricians'offices with a variety of medical complaints, concerns and questions. Atriage service can play a role in determining which patients need to seea physician and which do not. Many clinics use their own staff for thistriage service, but other clinics out-source to call centers. Similarly,many doctors' offices, clinics and hospital departments use call centersto answer their telephones on weekends and after business hours. Inaddition to handling scheduling and message services, these call centersoften use a level of triage to determine which calls warrant paging anon-call doctor.

Most triage calls begin with a nurse recording the medical condition orinjury as stated by the caller, along with the caller's demographicinformation. This is followed by questioning by the nurse and a shorthealth history. The nurse will assess the symptoms, provide informationon seeking care and improving symptoms, and refer the caller to aphysician, if necessary. Documentation of the call can be the final partof the triage process.

Many of the existing services described above provide a triage servicein which nurses apply a variation of the free-form triage, answeringcallers' medical questions using the nurse's own expertise or generalguidelines. While sample protocols, risk factors and other informationcan be provided, these systems do not establish a broadly applicable andconsistent decision-making process. Nurses are left to formulate theirown questions and direct their own investigations. Even with generalguidelines such a system can be rife with inconsistencies and otherlimitations. Each nurse can have his or her own particular predilectionsand can steer the inquiry in a direction not warranted by a fullerunderstanding of a particular patient's condition or optimal practicesobtained by methodical study of prior triage cases. The nurse can misscritical points as a result of sloppiness or lack of knowledge and can,as a result, direct more treatment or less treatment than isappropriate. It can be impossible to ensure consistency and qualitycontrol with this kind of system.

SUMMARY

The invention relates to a medical triage system.

Using the triage system, a medical triage disposition can be determinedfor a person. A plurality of triage categories includes questionsgrouped into a plurality of tiers ranked according to urgency. Each ofthe plurality of tiers corresponds to one of a set of triagedispositions. At least a first relevant triage category and a secondrelevant triage category can be selected from the plurality of triagecategories based on information about a medical condition of the personand then accessed. The person can be triaged by (a) identifying from allof the selected relevant triage categories a highest urgency tier thathas at least one unasked question; (b) asking the person one of the atleast one unasked question of the highest urgency tier; and (c)repeating (a) and (b) for all of the selected triage categories untilthe triage disposition is determined.

Other systems, methods, features and advantages of the invention willbe, or will become, apparent to one with skill in the art uponexamination of the following figures and detailed description. It isintended that all such additional systems, methods, features andadvantages be included within this description, be within the scope ofthe invention, and be protected by the following claims.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention can be better understood with reference to the followingdrawings and description, with emphasis placed upon illustrating theprinciples of the invention.

FIG. 1 is a schematic depiction of a platform for implementing triage.

FIG. 2 is a block diagram showing the possible hardware components of acomputer system for implementing triage.

FIG. 3 is a block diagram showing possible database components in acomputer system for implementing triage.

FIG. 4 is a schematic depiction of a call process for the triage system.

FIG. 5 shows a chart depicting four exemplary disposition sets.

FIG. 6 is another schematic depiction of a call process for the triagesystem.

FIG. 7 is a schematic depiction of a call process for the triage systemthat includes detailed notification procedures.

FIG. 8 is a schematic depiction of a format for a triage category.

FIG. 9 is a schematic depiction of one set of tiered triage questionsand corresponding dispositions.

FIG. 10A shows an exemplary triage category for upper extremityinjuries, including a set of tiered triage questions and correspondingdispositions.

FIG. 10B shows exemplary self-care instructions, follow-up criteria andfrequently asked questions associated with the triage category in FIG.10A.

FIG. 11A shows a schematic depiction of a zigzag-type alternationbetween sets of triage questions.

FIG. 11B is a schematic depiction of a step-type alternation betweensets of triage questions.

FIG. 12 is a schematic depiction of a method of alternating betweentriage questions in one triage category and another set of questions ina triage category added after triage was begun in the original category.

FIG. 13 shows a sample quantification tool for standardizing anddefining triage questions and responses.

FIGS. 14A-P show various exemplary screen formats for implementing atriage system on a computer.

DETAILED DESCRIPTION The Triage Platform

A schematic overview of a platform for implementing a triage system ofthe invention is shown in FIG. 1. Elements used in supporting andimplementing the triage system can be connected through a communicationsnetwork 100, including, for example, the Internet, an intranet, a localarea network and/or a wide area network. Additional elements not shownin FIG. 1 can be included in such a platform. The triage system can alsobe implemented with fewer elements than shown in FIG. 1.

The triage system can address the medical inquiries of individuals inany context in which injury management and triage is desirable.Application of the triage system can help reduce utilization ofexpensive, and often unnecessary, appointments with physicians andemergency room visits. By eliminating unnecessary physician appointmentsand visits to the emergency room, the system can also reduce unnecessaryrecordable injuries and unnecessary claims for Workers' Compensation.The triage system can also help ensure prompt, appropriate care, therebymitigating additional injury, reducing an individual's time away fromwork and preventing permanent disabilities. There can be direct costsavings by directing an individual to a preferred treatment center(where permitted by law) in which care is more appropriate or bettertailored to the individual's condition, and, in some cases, lessexpensive. The system can also encourage those who are ordinarilyreluctant to seek medical care to seek such care when they might benefitfrom it.

The triage system can include one or more triage centers 108 in whichone or more triage operators 110 communicate with individuals (e.g., acaller 105) who have contacted the triage center 108 with medicalconcerns or questions. The triage operator 110 can be in contact withthe caller 105 through the communications network 100 (e.g., usingtelephones) to allow for a remote triage investigation. The triageoperator 110 can work from anywhere he can connect to the communicationsnetwork 100, including from a triage unit 126, which can be connectedthrough the communications network 100 to the triage center 108. Thetriage operator 110 can also operate independently, for example, using anon-networked PC.

In other cases, however, the triage can be implemented in part by acomputer system 116, using voice recognition to process the answersoffered by the caller 105 and/or using voice generation to present thequestions to the caller 105 over the telephone or similar device. Acomputer system 116 can also present the questions in written form tothe caller 105, as in an Internet Web page, for example. The triageprocess can be implemented automatically using some of theabove-mentioned techniques.

The triage operator 110 can be a physician, surgeon, medical resident,physician assistant, nurse practitioner, registered nurse, paramedic,psychiatrist, dentist, pharmacist, other medical professional or otherperson trained to implement the triage system. In some cases,non-medically trained people can implement the triage system, if theyare properly trained to implement the triage system. It can be moreefficient to use registered nurses, because they are often trained ingeneral triage practices, can have relevant and useful general medicalknowledge and experience to place triage instances into context, andbecause their services can be less expensive than those of physicians.Someone with credentials less than those of a registered nurse can beutilized as the triage operator 110, although adequate supervision oflesser skilled triage operators 110 may be desirable to ensure that thetriage process is accurately implemented. Applicable laws andregulations in certain jurisdictions may require minimum licensure orcredentials separate from what the triage system requires in order toprovide medical advice or triage service in that jurisdiction.

The caller 105 can be anyone who makes contact with the triage operator110 or computer system 116 for the purposes of medical triage. Thecaller 105 can be the injured or ailing person, or anyone with medicalquestions. The caller 105 can also be someone who is assisting theinjured or ailing person, especially in situations where the injuredperson is not able to call or communicate over the telephone. Forexample, a supervisor can help an employee place such a call if theemployee is partially incapacitated. A supervisor can also place thecall on behalf of someone else when company policy so requires. Forsimplicity, it can be assumed herein that the caller 105 is the personwith the medical issue or complaint.

The caller 105 can use a telephone to call the triage center 108 ortriage unit 126, such as by using a toll-free (e.g. 1-800) number. Thecaller 105 can also use a mobile telephone, satellite telephone,walkie-talkie, computer via the Internet or other network, email,BLACKBERRY (Waterloo, Ontario), facsimile machine, two-way pager or anyother system for communicating from a remote location to the triageoperator 110.

In some situations, the triage system is provided to a clientorganization to serve its employees, customers, and/or those at itsfacilities 104. A caller 106 at the organization facilities 104 can bean employee or customer the client organization, or can have no relationwith the client other than being on its property. The clientorganization can also extend the application of its triage program tocallers 105 who are employees, including those off-site and/or not onthe job. Additional cost savings can result from improved productivityand morale, as a result of the prompt medical attention available to anemployee. Employees can be more satisfied with the level of care andthus more likely to comply with self-care instructions, and can be lesslikely to initiate litigation against the client organization.Furthermore, by shifting the medical decision-making from the clientorganization to the triage system provider, the risks inherent inmedical decision making are shifted away from the client organization.

A caller 128 who is mobile can contact a triage operator 110 frommultiple locations. For example, a long-haul truck driver can haveaccess to the triage system by contacting the triage center 108 ortriage unit 126 though the communications network 100 using any of thedevices mentioned above. The position of the mobile caller 128 can bedetermined with a tracking system such as the Global Positioning System(GPS) 130. This can assist in dispatching medical services to the mobilecaller 128 and/or directing the mobile caller 128 to a nearby treatmentcenter 118, 120. GPS software employed by the triage operator 110 canhelp interpret and present GPS-related data for the purpose of locatinga mobile caller 128. For example, the position of the mobile caller 128could be displayed on a display device 160 so that the triage operator110 or computer system 116 could help identify routes to a treatmentcenter 118, such as the nearest treatment center, or direct anappropriate medical provider to the mobile caller 128.

A caller 105 may require emergency assistance, such as assistanceprovided by an Emergency Medical Service (“EMS”) 124. A call to the 911call center 122 can be made by the caller 105 at the instruction of thetriage operator 110 if the triage disposition so warrants. The 911 callcenter 122 can in turn dispatch an ambulance by contacting the EMS 124,which will transport the caller 105 to a treatment center 118, 120.

Alternatively, the situation may not require emergency attention. Inthat case, the triage operator 110 or caller 105 can make an appointmentfor the caller 105 to see a medical provider (such as a physician,physician's assistant, nurse practitioner, dentist, nurse practitioner,nurse or other medical professional) at one of the treatment centers118, 120. Treatment centers 118, 120 include hospitals, clinics or otherlocations where medical care can be dispensed. One or more treatmentcenters 118 can be identified as a preferred treatment center, based onthe client specifications, the proximity of the treatment center 118 tothe caller 105 or client facility 104, the known capabilities of thetreatment center 118, etc. However, the system can comport with anyapplicable laws and regulations that govern (or prohibit) therestriction to, or selection of, preferred treatment centers. The triageoperator 110 or caller 105 can first attempt to use or contact apreferred treatment center 118; if that fails, he can then attempt touse or contact another treatment center 120.

Computer System

As shown in FIG. 1, the triage operator 110 can use a computer system116 to help implement the triage system. Alternatively, the triagesystem can be implemented without computers, such as with books. Thecomputer system 116 can be a client-server system, in which one or morecomputer clients 112 send requests to a server 114 and a server 114responds to requests from one or more computer clients 112. A “computerclient” can be broadly construed to mean computer hardware that requestsor receives the file, and “server” can be broadly construed to be thecomputer hardware that provides or downloads the file. The computersystem 116 can include a personal computer (PC), laptop computer,server, workstation, and the like, running any one of a variety ofoperating systems.

The computer client 112 can be any computer hardware, such as a PC,workstation, hand-held device, electronic book, personal digitalassistant, peripheral, etc. The computer client 112 can also be asoftware program running on a computer directly or indirectly connectedor connectable in any known or later-developed manner to any type ofcomputer network, such as the Internet. For example, a representativecomputer client 112 is a personal computer that is PENTIUM-based (Intel,Santa Clara, Calif.) and includes an operating system such as MICROSOFTWINDOWS (Microsoft Corp., Redmond, Wash.). The computer client 112 canalso include a Web browser, such as INTERNET EXPLORER (Microsoft Corp.,Redmond, Wash.). A computer client 112 can also be a notebook computer,a handheld computing device (e.g., a PDA), an Internet appliance, atelephone, or any other such device connectable to the computer networkor other communications network.

The server 114 can be any computer hardware, such as a computerplatform, an adjunct to a computer or platform, or any componentthereof, such as a program that can respond to requests from a computerclient 112. For example, the server can be a PENTIUM-based computer(Intel, Santa Clara, Calif.) running WINDOWS 2000 SERVER and executingMS SQL (Microsoft Corp., Redmond, Wash.) or ORACLE (Oracle Corp.,Redwood Shores, Calif.). The server 114 can also include a displaysupporting a graphical user interface (GUI) for management andadministration, and an Application Programming Interface (API) thatprovides extensions to enable application developers to extend and/orcustomize the core functionality thereof through additional softwareprograms.

The triage system can be implemented using software running on thecomputer system 116. In addition, the triage system can be implementedusing a transmission medium, such as one or more carrier wave signalstransmitted between the computer system 116 and another entity, such asanother computer system, a server, a wireless network, etc. The triagesystem can also be implemented using an API or a user interface.

Computer Hardware Components

A block diagram of the computer system 116 is shown in FIG. 2, showing anumber of different hardware components coupled by a data bus 150 toallow communication therebetween. The components can communicate viahardwire or wireless connections. The computer systems embodying thetriage system need not include every element shown in FIG. 2, andequivalents to each of the elements are intended to be included withinthe spirit and scope of the triage system.

The central processor 152 shown in FIG. 2 can run software that assistsin triaging the caller 105. The central processor 152 can, for example,be used to process information entered by a triage operator 110 into thecomputer system 116. The central processor 152 can be any type ofmicroprocessor, such as a PENTIUM processor (Intel, Santa Clara,Calif.).

A main memory unit 154 can also be a part of the computer system 116.Additional storage devices, such as a fixed or hard disk drive unit 164,a floppy disk drive unit 166, a tape drive unit 168 and/or opticalstorage devices such as a CD Rom drive 170 or a DVD drive 171 can act asadjuncts and/or alternatives to the main memory unit 154. The storagedevices, such as the DVD drive 171, in addition to the main memory unit154, can be used for storing and access to recordings of theconversations between the caller 105 and the triage operator 110,medical and other data related to the caller 105, triage-relatedsoftware and data used to execute the triage-related software.

The network interface 158, 159 can be any type of a device, card,adapter, or connector that provides the computer system 116 with networkaccess to a computer or other device, such as a printer. In the triagesystem, the network interface 158, 159 can enable the computer system116 to connect to a computer network such as the Internet or Ethernet.Software and data can also be loaded into the computer system via thenetwork interface 158, 159.

A display device 160 can be used to display, to the triage operator 110or others, any information related to the triage system, such as triagequestions to ask of the caller 105. The display device 160 can be anytype of display, such as a liquid crystal display (LCD) and the like,capable of displaying, in whole or in part, the triage categories orother outputs generated by the computer system 116.

One or more input devices 162 allow the triage operator 110 to enterinformation into the computer system 116, such as answers to triagequestions. The input device 162 can be any type of device capable ofproviding the inputs described herein, such as keyboards, numerickeypads, touch screens, pointing devices, switches, styluses, scannersand light pens. An input/output controller 156 can support the input andoutput devices.

Database and Software Components

FIG. 3 is a block diagram showing possible database components andsupporting architecture in a computer system 200 for implementing thetriage system. In the system of FIG. 3, a user 210 can interact with aback end 250 of the computer system 200 via a server 230 and a contentpresentation system 240. The computer system 200 can include one or morecustomer databases 280, one or more content databases 290, one or moretelephone databases 295 and one or more audio recordings databases 297and a data warehouse 215. The back end 250 can be located in a triagecenter 108 or off-site.

The user 210 can be a triage operator 110 capable of interacting withthe computer system 200. The user 210 can also be someone who inputs oraccesses data or triage-related information, updates the software in thecomputer system 200, or otherwise alters the computer system 200. Theuser 210 can also be someone who mines the data in the computer system200 to generate reports, such as call statistics, injury reports andother reports. The user 210 can include a client or representativethereof, who can generate and/or have instant and secure access tostatistical reports on employee call characteristics, incident rates andother parameters via the communications network 100.

The user 210 can access the computer system 200 through the Internet, aremote server, or a networked device through, for example, a server 230.Users 210 may also access the computer system 200 users using a widearea protocol (WAP), digitized voice signals, interactive televisionsignals, electronic mail systems, voice mail, direct mail, and variousmessaging systems, including short message service (SMS) systems. Theuser 210 may also interact directly with the back end 250. Access to theback end 250 can also be provided via one or more carrier wave signalsthat are accessible to the user 210 without requiring a server 230.

The back end 250 can consist of various elements connected by a LAN. Theelements of the back end 250 can include a file server running WINDOWS2000 SERVER; a database server running MS SQL (Microsoft Corp., Redmond,Wash.) or ORACLE (Oracle Corp., Redwood Shores, Calif.); phone serversrunning a WINDOWS 2000 platform; fax servers running a WINDOWS 2000platform (Microsoft Corp., Redmond, Wash.); an e-mail server runningMICROSOFT EXCHANGE; and UNIX-based e-mail server running SENDMAIL(Sendmail, Inc., Emeryville, Calif.) for back-up; a web server runningIIS (Microsoft Corp., Redmond, Wash.); a reporting engine runningCRYSTAL ENTERPRISE (BusinessObjects, San Jose, Calif.); and a NETSCREENfire wall device (Juniper Networks, Sunnyvale, Calif.). The system canrun 128-bit encryption such as VERISIGN (Verisign, Inc., Mountain View,Calif.) to ensure system security. Other elements and software can beadded to this back end 250. The back end 250 can also be implementedwith ACCESS (Microsoft Corp., Redmond, Wash.), DEVELOPER 2000 (OracleCorp., Redwood Shores, Calif.), or other reporting tools, including thereplacements or successors to these applications.

The architecture of the back end 250 can be a flexible design thatincludes real-time, database-resident support, permitting reportingcapabilities that can take advantage of E-mail/WAP/Voice-basedcommunication. As content is added to the back end 250 (e.g., in contentdatabases 290), the attributes of the content can be delivered to theuser 210 in near real time, using, for example a report generated in thedata warehouse 215 and presented to the user 210 via the contentpresentation system 240. The back end 250 can create queries to beprovided to a user 210 and can receive responses to the queries. Theback end 250 can also perform processing based at least in part on thequeries and the responses, along with information stored in itsdatabases and lookup tables, and helps determine the triage disposition.

The computer system 200 can also include a business logic processingsystem (not shown) connected to the server, to form a three-tiercomputer system. The business logic processing system can receivequeries or responses from the user 210. That information can be used toupdate the customer databases 280, as well as retrieve data andinformation from both the customer databases 280 and content databases290. The business logic processing system can also provide inputs to andreceive outputs from the data warehouse 215 and communicate with anyrules systems to apply one or more predetermined rules to the userqueries. These functions can be accomplished in the absence of adiscreet business logic processing system.

The data warehouse 215 communicates with the customer databases 280 andthe content databases 290 and other databases during the preparation ofreports or triage-related queries which can be provided to the user 210,such as with an on-screen display. The data warehouse 215 can alsoorganize and store data generated using the server 230 and/or a rulessystem. The databases 280, 290 can be, for example, SQL relationaldatabases and/or relational online analytical processing databases(ROLAP).

The customer databases 280 can include one or more databases for storingdata provided by users 210 and/or derived from inputs by users 210,including demographic information, answers to triage-related questions,dispositions, follow-up data, plans, or other inputs from the users 210.The customer databases 280 can have real-time capabilities for supportof the data warehouse 215. The MedfilesMOL™ database and the telephonesystem database described below can be components of the customerdatabase 280.

The content databases 290 can include one or more databases storingcontent that can be provided to a user 210 during operation of thesystem. The content databases 290 can include all of the information ofthe triage categories, including the tiered triage questions and relatedinformation, discussed below. The triage database described below may bea part of the content databases 290.

The content databases 290 can include the tiered questions, in additionto data that is “scored” in advance for one or more predeterminedcharacteristics. This is also referred to as “derived” data. The scoreddata can, for example, be maintained as a set of one or more tables ofscores. Certain quantitative or qualitative details about a medicalcondition can be assigned one or more scores based on severity. Deriveddata can be used in conjunction with look-up tables to accept queriesfrom the server 230 and provide appropriate responses. For example, agiven amount of pain, shortness of breath or extent of burns can bematched with a disposition through the lookup tables. Information inlookup tables can be more quickly and conveniently accessed in certaincircumstances.

The telephone databases 295 store and provide access to telephonenumbers, associated names and other telephone-related data. The audiodatabases 297 store digitized recordings of the calls.

The computer system 116 can execute dynamic updates to the screencontrols to change one or more properties, without having to make codingchanges and/or redeploy the triage-related software. Those propertiescan include position, size, backcolor, forecolor, border style, fieldinput length and tool tip text. The computer system can also executedynamic updates regarding whether a field receives focus when a Tab keyis pressed and/or the order in which fields receive focus when the Tabkey is pressed. These changes can be useful for refining the software toimprove work flow and ease of use without having to reprogram thecomputer system 116.

In the above description of FIG. 3, it should be understood that anyportion of the functionality provided by the computer system 200 couldbe provided by independent systems and/or different groupings of systemsthan illustrated in FIG. 3.

Triage Process

As shown schematically in FIGS. 4A-B, users of the triage system (e.g.,callers 105) can contact a triage operator 110 from a remote location.The caller 105 can, depending on the traffic to the triage center 108,be placed in a telephone system queue (step 304) until a triage operator110 is available. The phone system can require the caller 105 toindicate whether the call is for a new injury; those calls are movedahead of others in the queue who indicate that they are reporting oldinjuries. The triage center 108 can be located anywhere a triageoperator 110 or computer 116 employs the triage system.

The computer system 116 and software can work together to present thetriage operator 110 with information relevant to a caller's medicalcomplaints, prompt for specific questions related to the caller'ssymptoms, and record the corresponding answers. The triage operator 110can employ the information and questions within those categories todetermine which disposition (i.e., timing and level of medical care)best suits the caller 105, as described in further detail below. Thetriage system does not necessarily diagnose the caller's medicalcondition, although the triage system can be used in conjunction with adiagnosis system.

When the caller's turn has arrived, a triage operator 110 can answer thetelephone and implement the triage system. All telephone conversationscan be digitized and stored digitally on a hard drive and thentransferred to DVD; a call can also be stored on analog tape. The callrecording and the triage operator's computer inputs can both have arunning time-stamp so that they can be linked and/or synchronized tobetter enable one to understand the basis for the triage operator'sdecisions or the effectiveness of the triage questions, when analyzed ata later date.

Upon receiving a call, the triage operator 110 can begin by finding andconfirming the caller's location (step 308), so that the triage operator110 can dispatch medical services to the caller's location if necessary.The triage operator 110 can also use the location information todetermine if the caller 105 is eligible for services (step 310), e.g. apre-existing client, employed by a pre-existing client, a customer of apre-existing client, or otherwise entitled to services. An exemplarycomputer screen layout shown in FIG. 14A can be suitable for recordingsuch information.

Services can be denied to a caller 105 who is not eligible. If thecaller 105 is not eligible for services, he will be notified (step 312).However, if it is apparent that the caller 105 is in need of emergencymedical attention, the triage operator 110 can instruct the caller 105to contact the EMS and provide interim self-care instructions. If thetriage operator 110 wishes to contact the EMS on the caller's behalf, itcan be important to get an accurate description of the exact location ofthe caller 105 and information on the appropriate EMS, which the triageoperator 110 may not have in the database. Other demographic informationsuch as the caller's social security number or name can be used todetermine if the caller 105 is eligible for triage services or hascalled before, so that his medical records can be accessed, if theyexist.

The triage operator 110 can establish whether or not the caller 105already exists in the triage system database (step 316) using personaldata. If the caller 105 does not exist in the database, basic callerdata are solicited by the triage operator 110 and entered (step 322) viaany appropriate devices, such as a keypad, mouse, light pen, touchscreen, scanner, etc. The information can enable the system to follow-upwith the caller 105 or allow triage reports to be generated, asdescribed below.

The caller 105 may already be listed in the database. If so, thecaller's information is accessed. The exemplary computer screen layoutshown in FIG. 14A can be suitable for accessing such information. Oncethe caller data are entered (step 322) or accessed, the triage operator110 determines if the call is a report call only (step 324). A reportcall is a call in which no medical treatment is desired by the caller105, but merely establishes the caller's data for future contact and formore complete data records of injuries and reporting statistics fortriage client organizations. For a report call, interveningtriage-related steps are skipped (step 342) and the data collectionprocess is initiated, as described below. The call type can be selectedusing radio buttons, as described in reference to FIG. 14C, below.

If the call is not a report only call, then the process is continued(step 340), as shown in FIG. 4B, by determining if the call is afollow-up call (step 344). A follow-up call is a call based on a medicalcondition that was previously addressed by the triage system. If it is afollow-up call, the system is set up as a follow-up call (step 350) byaccessing the data related to the original incident, which can beassociated with the caller's personal data. This can enable thefollow-up call data and the original incident data to be linked withinthe database, and can help the triage operator 110 understand theearlier incident or condition. A follow-up caller 396 can also contactthe triage operator 110 and directly commence follow-up (step 350).

If it is not a follow-up call, the call is set up as an original call(step 352), enabling an initial inquiry into the caller's condition andpersonal data. The caller's age can be collected in order to determine asuitable level of care for the caller 105. For example, chest pains in a65-year-old can suggest a heart attack, while they might not for an18-year-old. If a caller 105 is identified as a minor, a “Pre-Triage forMinors” frame can become enabled, as further described in reference toFIG. 14C, which can give the option of selecting a type of legalconsent. Legal consent criteria can be required before the call canprogress, in order to prevent the unauthorized triage of minors. Aparental consent form on file with the triage center, over-the-phoneconsent from a parent, or an agreement on file with the clientorganization can generally allow minors to make full use of the triagesystem. The triage system can, however, allow for Emergent-911 andEmergent triage of minors under the legal principle of implied consent.Triaging can be discontinued following the Emergent-911 or Emergentquestions for minors, as it can become harder to claim that impliedconsent applies to a less urgent situation. For particular clients, the“Pre-Triage for Minors” frame can be disabled.

Next, the triage operator 110 can select the relevant triage categories(step 354). The categories can correspond to body parts and/or injurytypes that can be the focus of the triage inquiry. The categories can begenerally symptom-based. Each category contains both tiered triagequestions and related information. The tiered triage questions,described below, are related questions that can lead to one of a set ofpossible dispositions, depending on the answers provided. An exemplarycomputer screen layout that allows selection of relevant categories isshown in FIG. 14C.

The categories that relate to particular body parts can include“abdominal injury,” “abdominal pain without injury,” “chest pain withoutinjury,” “chest injury,” “dental injury,” “upper extremity pain withoutinjury,” “upper extremity injury,” “lower extremity pain withoutinjury,” “lower extremity injury,” “eye injury,” “eye chemicalexposure,” “red eye,” “groin strain,” “headache, typical,” “headache,new onset/atypical,” “head injury,” “low back injury with directtrauma,” “low back injury without direct trauma,” “low back pain withoutinjury,” “neck injury,” “pregnancy,” “shortness of breath,” etc.

The triage categories that are not necessarily related to a particularbody part can include “bites,” “blood-borne pathogen exposure,” “burns,”“electric shock,” “frostbite,” “general complaint,” “heat illness,”“insect bite or sting,” “insecticide exposure,” “openwounds/laceration,” “psychiatric conditions/stress,” “rash,” etc.

As shown in FIG. 4B, the triage operator 110 can ask the caller 105 oneor more questions about his complaints to ascertain the origin or causeof the caller's inquiry and allow the triage operator 110 to select therelevant categories (step 354). For example, if the caller 105 statesthat he fell off a ladder, thereby bumping his head and cutting his arm,the triage operator 110 can select the “head injury” and “laceration”categories. Both the supporting information and tiered triage questionsin those two categories—laceration and head injury—can be applied by thetriage operator 110 as further described below. If more than onerelevant triage category is selected, the categories can be prioritized(step 355). They can be prioritized based on the description the caller105 provides or rules implemented by the triage operator 110. Such arule can provide, for example, that the “chest pain” category always hasa higher priority than the “groin strain” category.

Both the category selection and the body part selection can beaccomplished in the exemplary screen layout displayed in FIG. 14C, wherethe body part (e.g., foot, neck, hand, torso), body part location 1 and2 (e.g., left/right/lateral/dorsal) are selected using combo-box fields672-676, and the category 678 is selected from a list. When the “Add”button 680 is selected, the combination of category and body part arerecorded and displayed in a window 682. The same category can be appliedmultiple times to different areas of the body by selecting the samecategory a second time while selecting different body parts. Forexample, the laceration category can be applied to both the hand and theelbow, as primary and secondary body parts. Likewise, differentcategories can be applied to the same body part, if, for example, thereis both a burn and an open wound at the same place. When all or some ofthe categories and body parts are selected, the triage operator 110 canuse the arrow buttons 684 to prioritize the selections, as shown in FIG.14C.

As shown in FIG. 4B, the information and questions within each of therelevant triage categories are applied to triage the caller's complaints(step 356), i.e., to determine a suitable triage disposition for thecaller 105. The possible gradations of disposition can correspond tourgency, as described below, especially with respect to FIG. 5. FIG. 4Bshows that the triage operator 110 determines either that a referral isrequired (step 358) as a result of the triage process (step 356) or not.Thus, there are two basic dispositions shown in FIG. 4B—“requiring areferral” and “not requiring a referral.”

If the triage inquiry results in a referral, the triage operator 110 cansearch for and refer the caller 105 to a preferred medical provider(step 366), including any preferred treatment centers. If there is nopreferred medical provider designated by the client, or if the preferredmedical provider cannot adequately address the caller's medicalcondition, the caller 105 can be referred to any other suitable medicalprovider. Alternatively, the caller 105 can be presented with a list oftreatment centers to choose from for referral, or can be allowed toselect his own referral clinic, depending on the client policy andapplicable laws and regulations. If the triage process does not resultin a referral, self-care instructions (step 364) can be given to thecaller. An exemplary screen format for displaying triage questions andenabling access to supporting information, including self-careinstructions, is shown in FIGS. 14D-E.

If the caller's condition allows, the triage operator 110 can collectmore information (step 368) about the caller 105, beyond that requestedat the beginning of the call. This information can include demographicdata, incident criteria, and other information. An exemplary computerscreen format for entering this information is shown in FIG. 14J.

The triage operator 110 can also inquire into other data that is ofspecial interest to the client organization, i.e. the special clientrequirements (step 370). For example, the client can require that everycaller 105 with a back injury be asked if he or she was wearing acompany-supplied back-belt at the time of injury. Other clients canrequire that every caller 105 with a laceration be asked whether he orshe was wearing safety gloves. An exemplary computer screen format forentering this information is shown in FIGS. 14M-N.

If there are no such client requirements, or once special clientrequirements are collected (step 376), the data acquired during thetriage process can be saved to a database (step 377). The data caninclude the identification of the caller 105 and triage operator 110,cause of injury, symptoms, answers to questions, triage disposition,instructions given by the triage operator 110 and the results fromcaller 105 follow-up, in addition to other information discussedelsewhere.

The databases for saving the post-triage data and the other acquireddata include the MedfilesMOL™ database 389, the triage database 390 andthe telephone system database 391. The triage database 390 is used forstorage and organization of the information obtained during a triagecall, and is implemented using an application interface which allowsreal-time updating and modification of the database. The MedfilesMOL™database 389 is implemented using a post-call processing softwareinterface that allows the development and editing of the triagesoftware, as well as the investigation of particular call histories. Thedata in the three databases can be saved for long-term storage in thedata warehouse repository 392 (i.e., a data warehouse). Data warehouseusers 393 can access the data to prepare reports, study aggregate callerdata and study the long-term efficacy of the triage system or elementsthereof. The databases 389, 390, 391 and the warehouse 392 can havesecurity features to prevent the unauthorized access to the confidentialmedical records or proprietary client information contained therein.

Once all of the selected information is saved to one or more of thedatabases (step 377), a report is generated and sent (step 378) topredetermined recipients. The recipients can include particular contactpersons at the client or others, as detailed below.

The system can present an opportunity to maintain the call record (step379). The client can have instructions not to save such information; ifso, the call can be terminated at this point, because the call can beconsidered complete. If there are instructions to maintain the callrecord, then the records are saved (step 384) using the MedfilesMOL™application 382. The MedfilesMOL™ application 382 can be used tomaintain demographic information, details about the call and anyincident, or other information.

Application of the triage system can result in the selection of aparticular disposition from a set of dispositions. A disposition is,generally, the action or actions to be taken by the triage operator 110or caller 105 to resolve the caller's condition. A particulardisposition within a disposition set can be identified by generalizedindicia such as numbers or letters to express the selected level ofcare. For example, a “#1” disposition can indicate the most urgent levelof care, indicating to the triage operator 110 that whatever actions areassociated with the “#1” level (e.g., calling 911) should be executed.In the same disposition set, a “#5” disposition can indicate the leasturgent level of care, indicating to the triage operator 110 thatself-care instructions, for example, should be communicated to thecaller 105. When general indicia are employed, the specific set ofinstructions associated with each of the indicia can be modified.Dispositions can also be expressed as the disposition instructionsthemselves (e.g., “call 911,” “see doctor within 24 hours,” etc). FIG. 5shows that the triage system can use a number of triage exemplarydisposition sets 396, 397, 398, 399, with varying stratification andlevel of specificity. These disposition sets 398 can account fordiffering levels of urgency, from someone who needs immediate medicalattention to someone who can treat himself.

FIG. 6 is a schematic depiction of the triage system, and offers a moredetailed description of the dispositions that can be assigned to acaller 105 based on the answers given to the triage questions. As shownin FIG. 6, an injured employee (step 400) is directed to notify thesupervisor (step 402) so they can call the triage center together (step404); this step reflects a common corporate policy requiring supervisorinvolvement following an injury. Otherwise, the employee (step 400) cancall the triage center directly (step 404). Once the triage center iscontacted, a triage operator 110 can begin to inquire into the detailsof the injury. This allows the triage operator 110 to select and applythe triage categories (step 406) to assign a disposition.

FIG. 6 shows six possible dispositions, but more or fewer could be used.The first four dispositions (steps 408, 410, 412, 414) are variations onself-care; self-care instructions can be given over the telephone orsent by e-mail or faxed to the caller 105 and his supervisor. Forexample, one possible disposition is that the employee would requireassurance that his condition is not serious and/or information, butwould return to work (step 408), after which the triage operator 110would follow up (step 416) using the particular follow-up informationassociated with the relevant categories of the previous call.Alternatively, the employee is sent home with self-care instructions andcan return to work for the next shift (step 414). If a follow-up isindicated, the system can schedule the follow-up automatically and thecaller 105 can be informed to expect a follow-up at a certain date andtime. The triage system can be integrated with the calendar functionMICROSOFT OUTLOOK (Microsoft Corp., Redmond, Wash.) to automaticallyschedule and/or document follow-up calls.

If the medical condition of the caller 105 is sufficiently serious, oneof the more urgent dispositions (steps 418, 420) is assigned. The caller105 can be directed to a designated medical facility for furtherevaluation and/or care (step 418). Also, a caller 105 can be directed toan alternative medical provider if that designated or preferred medicalprovider is unavailable or cannot effectively address the caller'scondition (step 420). The client can specify reasons for which a medicalprovider is preferred and conditions suitable for overriding thatpreference, consistent with applicable rules and regulations. For thesix dispositions detailed in FIG. 6, the client's claim manager can becontacted about the inquiry (step 424) and updated (step 426), asneeded. The software can generate reports that are suited to updatingthe claim manager and others. The employee will ideally return to work(step 428).

FIG. 7 shows another schematic depiction of the triage system. Thetriage process can be initiated with a telephone call to the triagecenter when an employee has an injury or medical concern (step 430). Inthis scheme, the supervisor can be notified (step 432) before atoll-free telephone call is placed (step 434). The triage operator 110triages the caller (step 436). The triage process can result in anon-site resolution (step 438), wherein the caller 105 is given on-sitetreatment or instructions for self-care without visit to an off-siteprovider. There may be no Workers' Compensation claims (step 438) whenthe employee returns to work (“RTW”) after being given medicalinformation (step 442), when on-site self-care is provided (step 444),or when an alternative duty is assigned to the employee (step 446). Withthese dispositions (steps 442, 444, 446), the triage operator 110follows up with the caller, as indicated by the relevant triagecategories (step 448).

Alternatively, the caller 105 will be referred to a medical provider(step 440). This can happen for any of the following dispositions:Emergent-911 disposition (step 458), Emergent disposition (step 456),Urgent disposition (step 454), or Non-Urgent disposition (step 452), asdetermined by the instructions associated with each of thesedispositions. Care is then transferred to the off-site provider (step460) per the selected disposition.

The triage center can update the data warehouse and then notify theclient organization of the particular injury and resolution (steps 450,452). Work sites, regional offices, franchise offices, division offices,etc. can be the recipients of such a report, or receive othercommunications regarding the injury or issue. Each of those levels canhave a particular interest in safety, human resources issues, Workers'Compensation issues, or other relevant issues. Likewise, a third-partyadministrator, insurance carrier, insurance broker, or other entity canbe contacted when the client so requests (step 452). Ultimately, it ishoped that the employee returns to work (step 454).

Triage Categories

Within the triage system, different triage categories are applied basedon the caller's complaints. The triage categories aggregate differenttypes of supporting information and germane inquiries that apply to theparticular conditions targeted by the categories. FIG. 8 shows schematicrepresentation of the various sections of an exemplary triage category480: Critical Considerations 482, Clinical Frame 484, Tiered TriageQuestions 486, Question Rationale 488, Self-Care 490 (including anoverview, self-care instructions, prevention advice and follow-upquestions), Frequently Asked Questions (“FAQ”) 492 and GeneralInformation 494. An exemplary screen format for accessing these sectionsis described with regard to FIGS. 14E-F.

Any of these sections can be accessed at any time by opening up frames,or can be automatically presented to the triage operator 110 when acertain category 480 is called up. For example, one or more of thesections 482-494 could open as a frame automatically as soon as aparticular category 480 is accessed, while others are available at theoption of the triage operator, by selecting a button, drop-down menu orother selection modality. The categories do not necessarily have all ofthese sections, and can have additional sections not listed here.

The Critical Considerations 482 section generally guides the triageoperator's questioning of the caller 105. The Critical Considerations482 section can be used to flag important information or safety concernsfor consideration during application of the tiered triage questions 486and alert the triage operator 110 to other important information relatedto the tiered triage questions 486. For example, when the triageoperator 110 decides to apply the abdominal injury triage category, theCritical Considerations 482 window appears on-screen before anyquestions are asked. The Critical Considerations 482 can alert thetriage operator 110 to the fact that an abdominal injury can result inpotentially life-threatening conditions, including the rupture of solidor hollow viscera and that an abdominal injury in a pregnant woman canresult in uterine abruption or rupture. If this were not known by atriage operator 110, he or she might incorrectly discount the level ofdanger that the caller 105 faces. The software can automatically presentthe relevant Critical Consideration 482 on screen when the category 480is selected, or it can be presented upon selection of an icon on thecomputer screen.

A Clinical Frame section 484 in a triage category 480 can be accessed bythe triage operator. Unlike the Critical Considerations section 482,this section can be structured as a text box in which the triageoperator 110 can type a short description of the mechanism, location andtime of injury and any treatment attempted and corresponding results. Atext box 662 for entering the clinical frame is shown in FIG. 14C.Alternatively, this section can actively request information, and suchrequests can be tailored to each triage category.

The Clinical Frame 484 can be important in determining the severity ofthe complaint. Answers to the questions provided in this section canhelp define the context for the injury or condition and alert the triageoperator 110 to important issues, as well as any other categories thatought to be applied in a given inquiry. For example, symptoms resultingfrom a fall can be treated differently depending on whether the fall wasfrom a 10-foot ladder or on level ground. A fall from a 10-foot laddercan alert the triage operator 110 to an increased potential severity ofthe condition and add to the list of, or cause the software toautomatically access, applicable triage categories and/or dispositions.

One of the basic features of the triage category 480 is the tieredtriage questions 486, which, when applied, can determine the dispositionof the caller. The tiered triage questions 486 are discussed below, inreference to FIG. 9.

For each prompted question in the triage questions 486, the triageoperator 110 can access the Question Rationale 488 section. The QuestionRationale 488 section can help triage operators 110 understand theprocess and provide guidance for real world situations that do not fitneatly into tiered triage questions 486. This section can also behelpful for triage operators 110 who are in training or who are using anew triage category or a triage category with which they are notfamiliar.

The Self-Care section 490 provides category-specific self-careinstructions to the caller 105 and a brief explanation of the condition,including measures the caller 105 might take to prevent a similarmedical condition in the future. For example, the self-care instructionsfor the upper extremity injury category shown in FIG. 10 include: theadministration of acetaminophen, aspirin, or ibuprofen; that theaffected area be elevated; that ice and/or heat be applied to theaffected area; and that work is modified to restrict lifting or forcedgrasp. This section 490 can include a list of symptoms that can developand for which follow-up and reevaluation is necessary (i.e., “redflags”). For example, in the “bite wounds” triage category, any sign ofinfection or loss of sensation can suggest that the caller 105 shouldcontact a medical provider immediately. The Self-Care section 490 caninclude general information about the category, discharge instruction,and a definition of all possible dispositions. This section can includeboth self-care as the ultimate treatment and interim self-careinstructions which are applied in the time before a medical facility canbe reached or other medical help arrives.

If the caller 105 asks questions about his condition, the triageoperator 110 can choose to answer the questions using his or her ownknowledge. In some cases, the triage operator 110 can find it helpful torefer to a Frequently Asked Questions section 492 of the triage categoryfor a brief explanation of the medical condition and answers to commonconcerns. For example, those being triaged for animal bite wounds oftenask if HIV can be transmitted to them as a result; the answer providedin the Frequently Asked Questions section 492 is that animals do nottransmit HIV.

The General Information section 494 can contain additional informationabout the condition or information not suited for the other sections.For example, hyperlinks to Internet sites, Local Area Network, or otherdata sources containing more detailed medical information can be put inthis section.

Tiered Triage Questions

As stated before, the triage questions can be tiered. That is, there aregroups of questions in each tier and the tiers are ranked by urgencylevel. For each tier there is a corresponding disposition that isappropriate for the urgency level of the tier. An exemplary format ofthe tiered triage questions is shown in FIG. 9. Tiers 500, 508, 514, 522are shown in FIG. 9. In this example, the highest urgency tier is theEmergent-911 tier 500. Each of the tiers can have a correspondingdisposition 506, 514, 518, 526, as shown in FIG. 9. An exemplary screenformat for displaying the tiered triage questions and accepting answerinputs from the triage operator 110 is shown in FIGS. 14D-F.

In the Emergent-911 tier 500, for example, there can be at least oneyes/no question. If any of the questions are answered “yes,” then thecorresponding disposition for that caller 105 is the Emergent-911disposition 506. The Emergent-911 disposition 506 can includeinstructions for immediate referral to an ER by the local EMS, and, likesome of the other dispositions, can include condition-specific interimcare instructions. The Emergent-911 disposition 506 can be modified toinclude other instructions. The Emergent-911 tier 500 can be designed sothat it can select those callers 105 who need quick transport, severepain relief and/or special emergency medical services, such as cardiacmonitoring and defibrillation capability. Emergent-911 is typically thehighest urgency disposition. Interim care instructions can be providedfor all categories when triaging results in an Emergent-911 disposition506, Emergent disposition 514, Urgent disposition 518 or Non-Urgentdisposition 526.

If all of the questions of the Emergent-911 tier are answered “no,” thenthe triage operator 110 moves to the Emergent tier 508. In the Emergenttier 508, there can also be a number of questions, for which any “yes”answer results in the corresponding Emergent disposition 514. AnEmergent disposition 514 can indicate that there should be an immediatereferral to a medical provider, but not by an EMS. However, if all ofthe questions in the Emergent tier are answered “no,” then the triageoperator 110 can move down to the Urgent tier 514.

If any of the Urgent tier 514 questions are answered “yes,” then theUrgent disposition 518 is warranted. An Urgent disposition 518 canrequire a referral to a medical provider on the day of the complaint orwithin 24 hours. If all of the answers to the Urgent tier questions are“no,” then the triage operator 110 should move to the Non-Urgent tier522. Any “yes” answers to any of the Non-Urgent tier 522 questionsshould result in the selection of the Non-Urgent disposition 526, whichcan require a referral to a medical provider within three days of thecomplaint.

In the example shown in FIG. 9, if there is a “yes” answer for an Urgenttier question, all remaining questions can still be asked of the caller105, including those in the Non-Urgent 522 or Self-Care tiers. This canbe in contrast to a “yes” answer for an Emergent tier 508 orEmergent-911 tier 500 question, for which the entire triage process canbe halted, and the disposition immediately implemented. The cut-offpoint in the triage process in which a disposition is selected butquestions of a lesser urgency are still asked can be set at anyparticular tier.

The self-care disposition 534 can be automatically selected (530) if allof the answers to the preceding triage questions are “no.” Thus, notiered triage questions are shown in this particular example, and theself-care disposition functions as a catch-all for those who do not fitin the other tiers. Alternatively, there may be triage questions in aself-care tier in order to assist in customizing the self-careinstructions for the caller's condition, or if there is a lower urgencytier, among other reasons. This Self-Care disposition 534 can requireself-care that is distinguishable from interim self-care, discussedabove. If there is an on-site triage operator 110, such as a nurse, thisnurse can help implement the Self-Care disposition.

As shown in FIG. 9, the triage questions from higher urgency tiers canbe asked before those of lower urgency. Within the “abdominal pain”category, for example, the question about shortness of breath is in theEmergent-911 tier and precedes the question about blood in the urinewhich is in the Emergent tier. There can be any number of questions ineach tier. Whether a “yes” or “no” answer is provided, the triageoperator 110 can record comments made by the caller 105 or the triageoperator's observations or thoughts. In some situations, the triagequestions can be answered by the triage operator 110 instead of thecaller 105.

For consistency, the triage system can be designed, as shown in FIG. 9,so that any “yes” answer to a question within a specific tier (typicallyindicating the presence of particular symptoms) results in the selectionof the disposition that corresponds to that tier. This ensuresconsistency and prevents error. The software can present the triagequestions as a list, grouped according to tier, and each having yes andno buttons. The selection of a “yes” answer using a button or drop-downmenu could immediately bring up a frame that contains the dispositioninformation. However, it is not necessary to require “yes” answers forselecting a disposition; “no” answers and combinations of “yes” and “no”answers can result in the selection of a particular disposition.Similarly, qualitative or quantitative information given by the caller105 can result in one of the possible dispositions, such as with thequantification tool described below. Any question that does not lead toa disposition can be excluded from any of the triage questions.

The questions can be symptom-based. That is, the questions can relate towhat the caller 105 can sense. This can allow a quicker and moreconsistent disposition of the caller 105 because it does not require anattempt at quantification or objectivity. This can also be a requirementfor selection of suitable triage questions. However, quantified detailsof the actual incident, if there was one, can also be used to determinea suitable disposition. The questions can also be history-based, thatis, addressing family history (e.g., family history of heart disease),social history (e.g., whether or not the caller 105 ever smoked) andpast history (e.g., whether the caller 105 has a history of heartdisease).

One aspect of the triage system can include its flexibility. It can bebeneficial to allow the triage operator 110 to revisit any of thequestions to review the answers or associated comments. The triageoperator 110 also has the ability to navigate between unanswered triagequestion groups within the same tier. Using a “Triage Navigator” screen,the triage operator 110 can jump directly to specific categories orspecific tiers within the triage questions. The Triage Navigator cantake the form of a drop-down list, or a pop-up window with links to theother categories, as shown in FIG. 14D. The system can also utilize theresponses to questions in other triage categories if the same questionappears again later in another triage category. The system can alsodetermine and consider the variation in responses to the same or similarquestions that are asked more than once during the triage process and,for example, alert the triage operator 110 to that fact.

FIG. 10 shows an exemplary triage category 480 for triaging upperextremity injuries including a set of triage questions. The elements ofthe category 480 can be displayed as shown, or elements or portionsthereof can be presented by computer frames automatically or on command.The category 480 includes supporting information such as CriticalConsiderations 482 in addition to the tiered triage questions 486. Thetiered triage questions 486 are set up similarly to those in FIG. 9, inthat any “yes” answer indicates the presence of a symptom and leads tothe selection of a corresponding disposition. There are four questiontiers 500, 508, 514, 522 shown in FIG. 10. No questions are associatedwith the Self-Care disposition 534.

The triage questions 486 and categories 480 can be drafted and organizedso that they satisfy a particular set of rules or so that they have aparticular set of characteristics, including those rules andcharacteristics discussed above. Having the triage questions 486 and/orcategories 480 standardized in this way throughout the triage system canhelp streamline the triage process and make the triage process morepredictable and/or consistent for the triage operator 110 and the caller105, thereby helping to ensure consistent results.

In an example of a set of rules, reflected in the triage category 480 ofFIG. 10, the triage questions 486 and/or categories are symptom-based.The triage questions 486 are organized according to urgency. Applyingthe triage questions 486 results in one of five dispositions:Emergent-911, Emergent, Urgent, Non-Urgent or Self-Care, correspondingto each of the tiers 500, 508, 514, 522, 490. Emergent-911 referrals maybe based on a caller's need for speed of transport by an EMS, painrelief and/or special emergency medical services, such as cardiacmonitoring and defibrillation capability. Emergent referrals areimmediate referrals to a medical provider when the user does not needthe specialized services of EMS, but requires an immediate evaluation.An urgent referral is a referral to a medical provider within about twodays of the disposition being selected. A Non-Urgent referral is areferral to a medical provider within several days of the dispositionbeing selected. A Self-Care disposition includes providing self-careinstructions to the caller 105 so that he can care for his illness orinjury. Additional dispositions can be “interim self-care” which relatesto providing information before an eventual visit to a medical providerand “report only” which can be appropriate when there is no need for anylevel of medical care but the call is still reported. These dispositionsare discussed further with reference to FIG. 9.

Further describing an exemplary set of rules, the questions are answered“yes” or “no” and can be answered by the triage operator 110, and arenot necessarily the answers given by the caller 105. Any questions thatare not yes/no questions can be eliminated from the set of tiered triagequestions. The rule set can require that “yes” answers always result inthe selection of the corresponding disposition. The questions 486 aretiered such that the first group of questions leads to an Emergent-911disposition, the second group of questions leads to an Emergentdisposition, and so on. For example, the question about significantgross deformity, which, if positive, leads to an Emergent-911disposition, precedes the question about swelling over joints, which, ifpositive, leads to an Emergent disposition. One of the dispositions isselected when all of the triage questions 486 are asked. Triagequestions 486 that do not add to the disposition are not included in thecategory 480. A clinical frame 484 can be requested via a prompt, asdescribed above, which can include information related to the time,place and mechanism of injury.

Multiple Relevant Triage Categories

Often, for a given inquiry, more than one category can apply. Whendealing with multiple categories, the software can facilitate thepresentation of all relevant categories on-screen, including the tieredtriage questions and supporting information. Additionally, the softwarecan prompt for answers to the highest urgency questions from all of therelevant categories before prompting for answers to the questions thatare of a lower urgency. For example, a user can call with symptoms that,following a brief consultation, are categorized as “abdominal painwithout injury” and “chest pain without injury.” The software wouldensure that all of the questions that result in an “Emergent-911”disposition from both the “abdominal pain without injury” and “chestpain without injury” categories are answered before moving on to thequestions that result in an Emergent disposition. Although it could bepossible to ask all of the abdominal pain questions before moving on tothe chest pain questions, this may cause an unnecessary delay of a 911call or other action if the subsequent triage of the chest pain resultedin a higher urgency disposition.

One way of applying two sets of triage questions simultaneously ispresented in FIG. 11A. This is termed a zigzag-type alternation. In thezigzag-type alternation, the questions in the Emergent-911 tier 544 froma first category 522 are asked, then the Emergent-911 questions 566 fromthe second category 522 are asked. Thereafter, the questioning returnsto the first category 550, and the process is repeated at the next tier,as shown in FIG. 11A. Any “yes” answers for the Category 1 triagequestions 550 can result in a selection of a corresponding disposition.Likewise, any “yes” answers, for the Category 2 triage questions 552 canresult in a selection of a corresponding disposition. If “no” answersare given to all questions in the Emergent-911 and Emergent tiers, thenthe questions of the remaining tiers 576, 580, 588, 590, 592, 594 inboth categories can be asked, without terminating the triage process atthe first “yes” answer.

FIG. 11B shows a step-type alternation for applying two sets of triagequestions simultaneously. In FIG. 11B, the Emergent-911 questions areasked from a first triage category 550; then the Emergent-911 questionsare asked from the second category 552. Instead of switching back to thefirst category 550, the triage operator 110 then asks the Emergentquestion 568 from the second category 552. Any “yes” answer for theCategory 1 triage questions 550 can result in a selection of acorresponding disposition. Likewise, any “yes” answer for the Category 2triage questions 552 can result in a selection of a correspondingdisposition. If “no” answers are given to all questions in theEmergent-911 and Emergent tiers, then the questions of the remainingtiers 576, 580, 588, 590, 592, 594 in both categories can be asked,without terminating the triage process at the first “yes” answer.

The zigzag-type alternation depicted in FIG. 11A can be better forasking triage questions of two different categories when it isestablished that one of the categories is more important of the two.However, the scheme illustrated in FIG. 11B can be superior in somecases because there is less switching between different subject matters,thereby streamlining the flow of the conversation and minimizing thepotential for either the caller 105 or triage operator 110 to becomeconfused. However, regardless of the type of alternation scheme applied,the triage operator 110 can decide which category to apply first; thisordering can be more important in situations where there are more thantwo relevant categories and when the triage operator 110 suspects that aparticular category or categories are more likely to yield a more urgentdisposition.

In the course of conducting a triage, a triage operator 110 candetermine that an additional triage category is warranted. It is notuncommon to discover information about the injury and its cause thatleads the triage operator 110 to suspect additional, perhaps moresevere, injuries. If the triage operator 110 determines that anadditional category is relevant, the software allows him or her to applythe triage questions of that category at any time in the triage process.

For example, a triage for a “laceration” can reveal that the lacerationextended into the eye. Thus, the “eye injury” category may need to betriaged along with the original laceration. Being able to immediatelyadd the additional triage categories increases the likelihood that amore urgent disposition can be found sooner. Furthermore, thehigher-priority questions of the after-added category can be posed tothe caller 105 first before alternating between the two categories asshown in FIGS. 11A and 11B.

An example of a scheme for asking questions of after-added triagecategories is shown in FIG. 12. As shown, the Emergent-911 (554) andEmergent questions 564 were asked of Category 1 (550), and “no” answerswere offered to all of the yes/no questions in those two tiers. Then inthe midst of the questions of the Urgent tier 576, it was discoveredthat a second category applies, so the triage operator 110 canimmediately skip 654 to the Emergent-911 (556) questions of that newcategory, Category 2 (552). If all of the questions of the Emergent-911tier 556 are “no” then the triage operator 110 continues to the Emergenttier questions 568. Again, if all of the answers are “no,” the Urgenttier 580 questions can then be asked. At this point, if the Urgent tier580 questions of Category 2 are all “no”, then the triage operator 110can continue with whatever Urgent tier 576 questions of Category 1 (550)have not been answered. If the answers to the Urgent tier 576 questionsare “no,” then the triage operator 110 can alternate between theremaining triage tiers 588, 590, 592, 594, as shown above. This can helpensure that any of the more urgent dispositions can be identified firstbefore alternating between the lower-urgency tiers.

Record-Keeping, Reporting and Data Mining

The triage system can collect and store caller 105 data, including alldata acquired during the triage process. The data is stored so that itcan be selectively accessed for the purposes of record-keeping,reporting and data mining. Standard software reporting tools, such asBUSINESSOBJECTS 6.5 or subsequent versions (BusinessObjects, San Jose,Calif.), or the MedfilesMOL™ application described above can be used toaccess data that conforms to any of a variety of parameters, includingdates, locations, individuals, company, corporate divisions, job type,age, etc. The record-keeping and reporting procedures can be customizedto meet a client's specific needs, including by having reports tailoredto particular state and/or industry requirements.

For example, the MedfilesMOL™ application can assist in OccupationalSafety & Health Administration—(“OSHA”) and state-mandatedrecord-keeping. This can include generating First Report of Injury andOSHA log updates. The application can identify recordable incidents bycomparing injury type and treatments to OSHA's recording criteria. TheMedfilesMOL™ application then tracks recordable cases and automaticallyupdates the OSHA log. The client can be given partial access to adatabase so that a current OSHA log can be printed or viewed at anytime, and, at year end, the OSHA-A summary can be generated.

The triage system can also improve the client's claim process system byproviding more timely, accurate, complete and consistent reporting ofinjury incidents. The system can also collect and manage informationwith which to investigate and/or challenge, defend against, or settlesuch a claim.

Details about particular calls can be kept on file at the triage center108 or elsewhere for auditing purposes. The triage software canautomatically generate short narrative reports about each call or caller105; these can be based on a pre-formatted report template. Reports,including narrative reports, can be automatically faxed, emailed, orotherwise communicated to the client or any interested division orentity listed above.

Users 210 can analyze the data to create reports, study injury trends,identify hazards, and compare one facility or department with another orwith industry benchmarks, pre-determined goals, or projected outcomes.The data gathered can also contribute to the maintenance of complete andaccurate company records, accessible to authorized company personneland/or others. Other reports can be automatically generated and sent toa company's safety officer, risk manager and/or insurance carrier totrigger accident investigation and preventive measures. The database ofthe system can be securely accessible to designated client managers viathe Internet or other means so that the client can have access to thesereports and other reporting options on demand. An exemplary computerscreen format for accomplishing these reporting functions is shown inFIG. 14O.

Allowing the compilation and analysis of injury statistics can behelpful in situations where it is suspected that a small percentage ofemployees of a client can account for a large or disproportionatepercentage of injury claims and costs. Users 210 can monitor particularcallers 105 who use the triage system at higher rates and/or are moreaccident-prone. For example, the triage system can be designed to notifya user 210 when a certain caller 105 has reached a predeterminedthreshold for use of the triage system or injury rate.

The user 210 can mine the existing injury data to discover injurypatterns or safety issues, including locations, job tasks, supervisors,or other criteria that may contribute to injuries. The system alsoallows users 210 to set injury threshold rates or other parameters forautomatic notification via the system. The parameters can include a daterange, site (e.g., “Store 315”), location (e.g., the loading dock), cityand state, call type, caller gender, triage category applied, triagedisposition, referral and/or treatment.

The user 210 can analyze the data to identify preventive measures,improve work safety rules and monitor compliance with work safety rules.For example, user 210 can assess whether any required safety equipmenthas an overall health or cost benefit. If the data reveal that wearingback-belts has no effect on back injury rates or costs over time, thenclient organizations can abandon the belts in favor of otherpreventative measures. Similarly, a manager can measure the rate ofcompliance with the safety measures. Customizing and automating thisprocess can further help loss-prevention. The client can also monitorthe performance of and cost-savings of the client's injury managementservice and the triage system itself.

The triage-related data can also be routinely mined to test theeffectiveness of and fine-tune the instructions or other informationdispensed by the triage operator 110. Various statistical methods canhelp pinpoint potential areas for improvement. This can help ensureoptimal, evidence-based care. For example, if the follow-up for allcallers 105 assigned to the Urgent disposition show unfavorableaggregate outcomes, the Emergent tier questions could be edited so thatthe Emergent tier captures a greater proportion of callers 105 or sothat the questions better select those for whom that disposition is mostappropriate. Triage questions and supporting information can bemodified, supplemented or removed. Such undesirable outcomes can includeboth adverse health-related results of the applied disposition (e.g.,when care is inadequate) and also when a level of care is excessive,resulting in unneeded expenditures. Alternatively, for example, theUrgent disposition could be modified, setting a smaller window of timein which to see a medical providers.

A threshold level of undesirable aggregate triage outcomes can be set.When the threshold level is exceeded, a user 210 can be alerted tomodify the triage system to reduce the level of undesirable aggregatetriage outcomes. Following any changes, the triage-related data can beagain analyzed to determine the efficacy of any modification that wasmade to the system.

Additional Features of the Triage System

The triage system can be adapted to a client's specifications. Thetriage inquiry can be tailored to individual divisions, location of theincident, or job type. Likewise, the triage system can be speciallyconfigured for a particular U.S. state, call type, patient gender,category, disposition, referral, impression, and/or treatment. Toaccomplish this, the system can include, exclude or modify certaintriage questions provided to the caller 105 or triage operator 110.Supporting information can also be included, excluded or modified. Theparticular client variations are identified and accessed as the caller105 is identified. These variations can also be keyed to the place orbusiness from which the caller 105 is calling. The triage system can,for example, suppress any data from being collected.

In a triage center, there can be triage operators answering thetelephones and performing triage, and, in addition, a manager whomonitors the center. An additional feature of the triage system can be a“Flag Review” button, which allows the triage operator 110 to flag acall for review by a manager. The “Flag Review” button can be used toidentify a problem with the caller 105 or the way the triage categoryfunctions during the call. It can be used for immediate assistance, orfor identifying possible areas for long-term improvements.

The triage system can allow for different types of system overrides. Onekind of override is the 911 Override, which allows the triage operator110 to immediately bypass the remaining triage process and call 911 ordirect the caller 105 or the caller's supervisor to call 911. If thetriage operator 110 feels the caller's condition has become dangerousand requires EMS dispatch, clicking this button by-passes triage andexpedites the 911 referral. The 911 Override can be employed at any timein the triage process. The 911 Override can be accessed by a singlebutton that is always present on the computer screen. The user can see apop-up screen requesting entry of a caller's name, and a call-backtelephone number.

Another kind of override, Triage Operator Override (“TO Override”),allows a triage operator 110 the ability to immediately bypass theremaining triaging of a caller. This TO Override feature also allows thetriage operator 110 to automatically navigate to the Provider Search(Referral) screen at any point during the call flow. This allows thetriage operator 110 to use his own discretion and professional judgmentto, if desired, substitute a disposition that he feels is more prudentthan that provided by the triage system. While a computerized triagesystem provides a valuable framework for triage, it is recognized thatthe software cannot anticipate the infinite number of variables andsituations that a triage operator 110 can face. The TO Override featurehelps the triage operator 110 address a situation in which he believesthere is a more logical, safe or appropriate response than what thesoftware has indicated. TO Override can also be used when, for example,the triage disposition is Self-Care, but the caller 105 insists on areferral. Selection of the TO Override feature can prompt the display ofthe Provider Search (i.e., Referral) screen.

A system override can prompt the triage operator 110 to provide thereason for the override and flag the call for manager review. The reasonfor the override can be indicated in an electronic record linked to thecall record, but can be excluded from reports to the clientorganizations or government agencies, consistent with applicable lawsand agreements with clients.

With some conditions, it can be important to obtain from the caller 105quantitative details about the symptoms or cause of the ailment.Quantification tools supported by the software can be used by the triageoperator 110 to quantify symptoms. Quantification tools can deal withthe extent of bleeding, the amount of pain, shortness of breath, extentof burns, time of a possible rabies-infecting bite, and tetanus status.A quantification tool can, for example, help the triage operator 110decide if bleeding can be considered “severe” bleeding. FIG. 13 shows anexemplary quantification tool 597 for determining whether a wound isdeep or not. The triage operator 110 can ask some of the questions 598within the quantification tool 597 and thereby choose the proper yes/noconclusion 598 about the wound depth. An icon can appear to the left ofany triage question involving one of these symptom patterns, and canopen a document with quantifying information to aid in answering theaccompanying question. The information can assist in the selection oftriage categories or selection of a disposition within a triagecategory. The quantification tools also provide standardization betweenthe triage operators so triage results are consistent.

The time elapsed between an injury and the time the injured personcontacts the triage operator 110 can be a factor in the triage analysis.For example, if a caller 105 is concerned about the possibility of abroken bone, a call immediately after the incident may not reveal someof the more important symptoms—whether there is swelling or bruising,for example. Therefore, the system can alert the triage operator 110 tothe elapsed time and its relevance, modify questions based on theelapsed time (including eliminating questions that would not haverelevance at a particular time and/or automatically adding others), havequestions automatically answered in certain ways based on the timeelapsed and indicate whether it is important for the caller 105 tofollow-up at a later time. The elapsed time can otherwise be used todetermine a disposition, such as, for example, when the incident was solong ago that nothing more than self-care is needed. The system can alsomake note of what time the event occurred in the caller's time zone,which will then be adjusted for a correct calculation of the elapsedtime. This information can become part of the recorded triage-relateddata and stored in the database with the answers to the triagequestions.

Screen Formats and Selection Modalities

FIGS. 14A-P show various exemplary computer screen formats and selectionmodalities that can be used to help implement the triage system on acomputer.

FIG. 14A shows a screen 600 that enables the identification of thecaller 105 so that the triage-related data, including any informationrelated to triage outcomes, can be associated with his demographic orpersonal information and so that client preferences can be applied tothe call. When the triage operator 110 answers the call from the caller105, the triage operator 110 can select the “Start Call” button 602,which can time-stamp the phone call and enable the triage system to beimplemented. A menu bar 605 allows for selection of various actions andparameters, including exiting the program and changing program options.

As described above, the triage system car be implemented for a corporateclient. Thus, the caller 105, if he is an employee, can be asked toidentify the company for which he works, including the particular site,or where he is located. The company can be selected using a combo-boxfield 606, and the site can be selected using another combo-box field610. As an alternative, search fields can be filled out, such as company608, zip code 602, state 609, city 614, address 616 and phone number618. Once selected fields are entered, the “Search” button 611 can beselected to generate a list of matching companies 622 in the companyfield 620. If one of the matching companies 622 is the correct one, itcan be selected by double-clicking or other selection method.

The caller 105 can be asked if he is already in the database; if he is,the “Existing Person Call” button 604 is selected and the informationabout the caller 105 is accessed. Any number of search fields can befilled out to search for the relevant demographic data, including lastname 624, first name 626, social security number 630, type of employee632, gender 634, birth date 636, and job status 638. The entire databasecan be searched by checking the appropriate box 627, or the search canbe restricted to a particular company by checking a different box 625.Once one or more fields are entered, the triage operator 110 can selectthe “Search” button 639, which brings the various matching identitiesinto the person field 640, where the corresponding identity can beselected.

As shown in FIG. 14B, if the caller 105 is not in the system, the “NewPerson Call” button 644 is selected, and, as a result, the “CreatePerson” dialog box appears, having text fields 652 and combo-box fields653, for entering demographic information such as birth date, socialsecurity number, gender, etc. Once all of the information is entered,the information can be saved by selecting the “Save” button 654, atwhich point the “Create Person” dialog box 651 disappears.

By selecting the “Close” button 645, the next screen 650 appears, inwhich the relevant triage categories can be selected, as shown in FIG.14C. While the text box 662 can be used for any relevant information, itcan also be used to enter the answers that the caller 105 provides forthe introductory questions regarding the context or mechanism of injury,which can be a first step in the selection of the relevant triagecategory. The initial questioning can also help determine if the call isan injury, follow-up or report-only call, which can be selected usingthe radio buttons 663. Toward the beginning of the call, the triageoperator 110 can request the age of the caller 105. If a birthdayentered in the age box 664 indicates that the caller 105 is a minor,then the triage operator 110 can select one of the legal consentcategories 668 described above in order to proceed. The system canprevent the triage operator 110 from proceeding if there is noindication of consent, although this feature can be disabled. Aninformation bar 661 is visible throughout the call, indicating the nameof the caller 105, as well as the name and location of the company forwhich the caller 105 works, the reference number for the call and thecall type.

The triage categories can be selected in category selection box 670 ofFIG. 14C from the list of categories 678. To apply the chosen category,the applicable information is selected using combo-boxes correspondingto body parts 672, body part location 1 (674) and body part location 2(676). The body part location combo-boxes include such descriptors asdorsal, lateral, anterior, posterior, left, right, etc. Once these havebeen selected, the “Add” button 680 is selected, which saves theselected combination in the relevant triage category list 682. Thisprocess can be repeated using different categories and/or different bodyparts until there are no more relevant categories for the caller'sparticular condition. Using the arrows 684, a plurality of categoriescan be ordered in terms of importance or other criteria. Selectedcategories can also be removed using the “Remove” button 686. Also, the“911-Override” button 690 and the “Triage Operator Override” button 692can be selected throughout the triage process. Once the selectionprocess is finished, the triage operator 110 can select the “Continue”button 688 to move to the screen of FIG. 14D.

The screen 700 of FIG. 14D starts the triage questioning based on thecategories selected in the previous screen 650. The triage questioningstarts with the questions in the highest urgency tier of the highestpriority category, which are identified by the question identification712 bar. The Triage Navigator 714 shows which tier of questions iscurrently being asked 716 and which tier of questions is next 718, basedon the tier list 715. When asking the triage questions, the triageoperator 110 can access the quantification tool 708 which displays amethodology for quantifying certain symptoms. The triage operator 110can also select the button 710 to open a text box that allows the entryof additional information acquired from the caller 105 in the course ofanswering a particular question.

As stated above, the Critical Considerations section can be accessedthroughout the triage process. In the screen shown in FIG. 14E, thissection can be selected using the “Critical Considerations” button 722,which opens a window containing the relevant information. Someadditional features that can be available through the triage process arethe “Change Call Type” button 730 (for alternating between a follow-upcall, new call and report-only call), the “D/C” button 726 (foraccessing self-care instructions and FAQs), the “Triage Navigator”button 724, the “General Information” button 729 and the “Flag Review”button 728, which are all discussed above. Furthermore, there arebuttons for accessing a prior call menu 731, accessing a list ofoutgoing follow-up calls to be made 733, printing the screen 735,closing all screens 737 and exiting the program 739. The “ProtocolManagement” (i.e., Category Selection) button 741 allows the triageoperator 110 to return to the screen 650 shown in FIG. 14C to selectadditional categories or to change categories.

The triage screen 700 of FIG. 14F shows multiple triage categories beingapplied. In particular, FIG. 14F shows Open Wounds 740 and Frostbite742, as indicated in the Triage Navigator 744. The Triage Navigator canbe used to view any of the completed or active tiers in any of theselected categories. Because one of the questions has been given a “yes”answer 734, the Disposition box 738 shows the selected disposition andthe Triage Navigator 744 shows that the caller 105 has been referred748. Because the disposition is Emergent, the triage status box 736shows that the triage process has been completed; if, however, theselected disposition was of a less urgent nature, the protocol statusbox 736 may not show that the triage process has been completed untilall of the triage questions in all tiers have been asked, as describedabove. The “Continue” button 749 can be selected to move to the nextscreen.

The screen 800, shown in FIG. 14G, allows the triage operator 110 tofind an appropriate medical provider, and offers a number of differentsearch modes. For example, the search can be restricted to designatedmedical facilities, client specifications, or can be expanded to allproviders using a number of radio buttons 804. Alternatively, any numberof fields 802 can be filled to search the provider database. The resultsof the search show up in a list 806. Details about the medical providercan be obtained by selecting the “Open Prov” button 814 which opens atext window. The “Referrals List” button 816 can be selected to obtainthe referrals for a particular medical provider. Directions to aprovider can be obtained by selecting the “Get Directions” button 812,which can access a map or directions from any appropriate service orsoftware, such as MAPQUEST.COM. If a medical provider is not in thedatabase, the medical provider can be entered by selecting the “NewProvider” button 808 and entering the new provider fields 810.

Once a medical provider has been selected, the “Refer” button 830 isselected, which opens the caller referral window 832, shown in FIG. 14H.The caller referral window 832 summarizes the referral by providing thedate of referral 836 and other information. A button 840 can also allowa map to the medical provider to be generated. A number of details aboutthe nature of the referral can be selected; these are indicated asExceptions 834 to an ordinary call, and include such details as whetherthere was a self-referral by the caller 105, whether the caller 105requested an appointment, refused a recommendation, etc. The Exceptions834 also allows the referral information to be printed on the medicalreport.

Once the “Save” button 838 is selected, the information is saved in arecord 842, and the triage operator 110 can select the “Continue” button844 to move to the next screen 850, shown in FIG. 14J. Furtherdemographic information can be acquired, such as personal information852, home address 854 and employment data 856. The “Continue” button 858can be selected to move to the next screen 900, shown in FIG. 14K.

When a particular call is selected from the call list 901, a summary ofthat call is displayed in the various fields of a screen 900 shown inFIG. 14K. When the “Open” button 903 is selected, a narrativedescription 902 of the call is generated and displayed, as shown in FIG.14L. The narrative description can be closed using the “Close” button904, and the next screen 950 can be accessed using the “Continue” button906.

The screen 950 shown in FIG. 14M allows additional demographicinformation to be entered, including a Workers' Compensation ClaimNumber 952, family information 954, employment information 956, andcontextual information relating to the incident itself, including thetask performed at the time of incident 958, the objects or substancesinvolved 960, the details about the occurrence of the injury 962, andthe supervisor's name 964. After this information is input, the nextscreen 970, shown in FIG. 14N, permits the recording of informationspecific to the employer of the caller 105, such as compliance withparticular safety procedures 972. Some of these special requirements canbe printed, and if printed, will show up in a text box 974. Additionaltext 976 can alert the triage operator 110 to any other detailsparticular to the caller's employer. When this information is entered,the “Continue” button 978 is selected to access the next screen 990.

The next screen 990, shown in FIG. 14O, displays the details of theautomated communications 991 that will be sent on command, including thedestination, the report name, the recipient, and the output format. Thelist of communications can be selected or deselected using check-boxes992. The method 993 of the communication can include e-mail and fax, butall other communication methods described above can be employed. Oncethe selections are made, the “Send” button 994 is selected. In FIG. 14P,the final screen 995 is shown. The Call Complete 996 or Call PendingInformation 997 boxes can be checked, after which the “Finish” button998 is selected to complete the call.

While various embodiments of the triage system have been described, itwill be apparent to those of ordinary skill in the art that many moreembodiments and implementations are possible within the scope of thetriage system. Accordingly, the triage system is not to be restrictedexcept in light of the attached claims and their equivalents.

1. A method of determining a medical triage disposition for a person,comprising: providing, by a computer to a triage operator, a pluralityof triage categories comprising body parts, injury types, symptoms, or acombination thereof, wherein each of the plurality of triage categoriescomprises questions grouped into a plurality of tiers ranked accordingto urgency, and wherein each of the plurality of tiers corresponds toone of a set of triage dispositions; providing, by the computer to thetriage operator, a selection of at least a first relevant triagecategory from the plurality of triage categories based on answersreceived from the person in response to an initial inquiry into amedical condition of the person; providing, by the computer to thetriage operator within a computer screen layout, access to questions ofthe selected at least first relevant triage category; and providing, bythe triage operator with access to the computer, triage to the personremotely, away from a treatment center, without medical equipment andwithout need of a trained medical person, through a form of remotecommunication, wherein providing triage comprises: (a) identifying fromthe selected at least first relevant triage category a highest urgencytier that has at least one unasked question; (b) asking the person oneof the at least one unasked question of the highest urgency tier; (c)receiving a response from the person to the at least one unaskedquestion; (d) identifying during triage within the at least firstrelevant triage category at least a second relevant triage category; (e)selecting the at least second relevant triage category while performingtriage in the at least first relevant triage category; and (f) repeating(a) through (c) for the selected at least first and second relevanttriage categories until the triage disposition is determined, whereinthe triage operator is provided simultaneous access through the computerscreen layout to the questions of the at least first and second selectedrelevant triage categories.
 2. The method of claim 1, wherein theselected at least first and second relevant triage categories areselected before (a) is performed.
 3. The method of claim 1, wherein theselected at least first relevant triage category comprises at least twocategories.
 4. The method of claim 3, wherein the selected at leastsecond relevant triage category comprises at least two categories. 5.The method of claim 1, further comprising providing at least onedatabase supported by the computer for storing triage-related data. 6.The method of claim 5, further comprising accessing the triage-relateddata, wherein the triage-related data comprise demographic data relatedto the person.
 7. The method of claim 5, further comprising accessingthe triage-related data, wherein the triage-related data comprise datarelated to any previous communication with the person.
 8. The method ofclaim 1, further comprising presenting a rationale for one of thequestions when the computer is queried by the triage operator.
 9. Themethod of claim 1, further comprising the triage operator overriding thetriage disposition if the triage operator prefers a differentdisposition.
 10. The method of claim 1, further comprising the triageoperator overriding the triage disposition if the person warrantsimmediate medical attention.
 11. The method of claim 1, furthercomprising performing a follow-up medical interview.
 12. The method ofclaim 1, wherein the questions comprise yes/no questions.
 13. The methodof claim 12, wherein a first “yes” answer received in response to one ofthe yes/no questions directly results in a determination of the triagedisposition, and wherein the triage disposition corresponds to the tierwhich contains the affirmatively-answered question.
 14. The method ofclaim 1, wherein the set of triage dispositions comprise: emergent-911transport by an emergency medical service to a medical provider;emergent referral immediately to a medical provider; urgent referral toa medical provider within about two days of the disposition beingselected; non-urgent referral to a medical provider within several daysof the disposition being selected; and self-care instructions.
 15. Themethod of claim 14, further comprising: providing interim self-careinstructions to the person in anticipation of an eventual visit to amedical provider; and only reporting a call when no medical care isdetermined to be necessary.
 16. The method of claim 1, wherein each ofthe triage categories further comprises supporting information, themethod further comprising providing access to the supportinginformation.
 17. The method of claim 16, wherein the supportinginformation is selected from a group consisting of: criticalconsiderations; clinical frame; frequently asked questions and answersthereto.
 18. The method of claim 1, further comprising reportingselected triage-related data to an employer of the person.
 19. Themethod of claim 1, wherein providing triage further comprisesalternating between questions of the selected at least first and secondrelevant triage categories using one of a step-type alternation or azigzag-type alternation.
 20. The method of claim 1, wherein remotelyincludes without access to vital signs of the person.
 21. The method ofclaim 1, wherein the form of remote communication includes one chosenfrom the group consisting of a mobile device, a facsimile machine, acomputer, and a telephone.
 22. The method of claim 1, wherein triagedispositions are final determinations whether and to what level ofmedical care the person is directed.
 23. The method of claim 1, whereinthe triage operator need not be medically trained, the method furthercomprising: quantifying a symptom of the person by the triage operatorwith a quantification tool of the computer that includes additionalquestions and standardization between multiple triage operators.
 24. Acomputer program product readable by a computing system and encoding acomputer program of instructions for executing a computer process, by aprocessor, for implementing a system to medically triage a person, thecomputer process comprising: providing a plurality of triage categoriescomprising body parts, injury types, symptoms, or a combination thereof,wherein each of the plurality of triage categories comprises questionsgrouped into a plurality of tiers ranked according to urgency, andwherein each of the plurality of tiers corresponds to one of a set oftriage dispositions; selecting at least a first relevant triage categoryfrom the plurality of triage categories based on answers received fromthe person in response to an initial inquiry into a medical condition ofthe person; accessing questions of the selected at least first relevanttriage category through a computer screen layout; and providing triageto the person remotely, away from a treatment center, without medicalequipment and without need of a trained medical person, through a formof remote communication, wherein providing triage comprises: (a)identifying from the selected at least first relevant triage category ahighest urgency tier that has at least one unasked question; (b)presenting one of the at least one unasked question of the highesturgency tier to the person; (c) receiving a response from the person tothe at least one unasked question; (d) identifying during triage withinthe at least first relevant triage category at least a second relevanttriage category; (e) selecting the at least second relevant triagecategory while performing triage in the at least first relevant triagecategory; and (f) repeating (a) through (c) for the selected at leastfirst and second relevant triage categories until the triage dispositionis determined, wherein the triage operator is provided simultaneousaccess through the computer screen layout to the questions of the atleast first and second selected relevant triage categories.
 25. Thecomputer program product of claim 24, wherein selecting the firstrelevant triage category is in accordance with an input from the triageoperator.
 26. The computer program product of claim 24, whereinaccessing the selected relevant triage categories is in accordance withan input from the triage operator.
 27. The computer program product ofclaim 24, wherein presenting one of the at least one unasked questioncomprises the triage operator speaking one of the at least one unaskedquestion to the person over a telephone.
 28. The computer programproduct of claim 24, wherein remotely includes without access to vitalsigns of the person.
 29. The computer program product of claim 24,wherein the form of remote communication includes one chosen from thegroup consisting of a mobile device, a facsimile machine, a computer,and a telephone.
 30. The computer program product of claim 24, whereintriage dispositions are final determinations whether and to what levelof medical care the person is directed.
 31. A system for enabling atriage operator using a computer to implement a triage system to aperson, comprising: a computer system having stored thereon: a databasehaving at least a plurality of triage categories comprising body parts,injury types, symptoms, or a combination thereof, wherein each of theplurality of triage categories comprises questions grouped into aplurality of tiers ranked according to urgency, and wherein each of theplurality of tiers corresponds to one of a set of triage dispositions;programming code for providing a selection of at least a first relevanttriage category from the plurality of triage categories based on answersreceived from the person in response to an initial inquiry into amedical condition of the person; programming code for providing accessto questions of the selected at least first relevant triage categorythrough a computer screen layout; and programming code for providingtriage to the person remotely, away from a treatment center, withoutmedical equipment and without need of a trained medical person, througha form of remote communication, wherein providing triage comprises: (a)identifying from the selected at least first relevant triage category ahighest urgency tier that has at least one unasked question; (b) askingthe person one of the at least one unasked question of the highesturgency tier; (c) receiving a response from the person to the at leastone unasked question; (d) identifying during triage within the at leastfirst relevant triage category at least a second relevant triagecategory; (e) selecting the at least second relevant triage categorywhile performing triage in the at least first relevant triage category;and (f) repeating (a) through (c) for the selected at least first andsecond relevant triage categories until the triage disposition isdetermined, wherein the triage operator has simultaneous access throughthe computer screen layout to the questions of the at least first andsecond selected relevant triage categories.
 32. The system of claim 31,further comprising providing a communications system supporting remotecontact between the person and the triage operator.
 33. The system ofclaim 32, wherein the communications system comprises at least onetelephone operatively connected to a network.
 34. The system of claim31, wherein remotely includes without access to vital signs of theperson.
 35. The system of claim 31, wherein the form of remotecommunication includes one chosen from the group consisting of a mobiledevice, a facsimile machine, a computer, and a telephone.
 36. The systemof claim 31, wherein triage dispositions are final determinationswhether and to what level of medical care a person is directed.
 37. Thesystem of claim 31, wherein the triage operator need not be medicallytrained, the system further comprising: programming code for quantifyinga symptom of the person by the triage operator with a quantificationtool of the computer system that includes additional questions andstandardization between multiple triage operators.
 38. A method ofdetermining a medical triage disposition for a person, comprising:providing, by a computer to a triage operator, a plurality of triagecategories comprising body parts, injury types, symptoms, or acombination thereof, wherein each of the plurality of triage categoriescomprises questions grouped into a plurality of tiers ranked accordingto urgency, and wherein each of the plurality of tiers corresponds toone of a set of triage dispositions; providing, by the computer to thetriage operator, a selection of two or more distinct, relevant triagecategories from the plurality of triage categories based on answersreceived from the person in response to an initial inquiry into amedical condition of the person; providing, by the computer to thetriage operator within a computer screen layout, simultaneous access toquestions of the selected two or more relevant triage categories; andproviding, by the triage operator with access to the computer, triage tothe person remotely, away from a treatment center and without need ofmedical personnel, through a form of remote communication, whereinproviding triage comprises: (a) identifying from all of the selectedrelevant triage categories a highest urgency tier that has at least oneunasked question; (b) asking the person one of the at least one unaskedquestion of the highest urgency tier; (c) receiving a response from theperson to the at least one unasked question; and (d) repeating (a)through (d) for all of the selected triage categories until the triagedisposition is determined.
 39. The method of claim 38, wherein therelevant triage categories are selected before (a) is performed.
 40. Themethod of claim 38, wherein the relevant triage categories are selectedat different times.
 41. The method of claim 40, wherein (a) and (b) havebeen performed at least once before selecting a second relevant triagecategory.
 42. The method of claim 38, further comprising providing atleast one database supported by the computer for storing triage-relateddata.
 43. The method of claim 38, further comprising the triage operatoroverriding the triage disposition if the person warrants immediatemedical attention.
 44. The method of claim 38, wherein triage isprovided without access to medical equipment and wherein the triageoperator need not be medically trained, the method further comprising:quantifying a symptom of the person by the triage operator with aquantification tool of the computer that includes additional questionsand standardization between multiple triage operators.
 45. A system forenabling a triage operator using a computer to implement a triage systemto a person, comprising: a computer system having a processor and storedwithin memory thereof a database having at least a plurality of triagecategories comprising body parts, injury types, symptoms, or acombination thereof, wherein each of the plurality of triage categoriescomprises questions grouped into a plurality of tiers ranked accordingto urgency, and wherein each of the plurality of tiers corresponds toone of a set of triage dispositions; programming code, executable by theprocessor, for providing a selection of two or more distinct, relevanttriage categories from the plurality of triage categories based onanswers received from the person in response to an initial inquiry intoa medical condition of the person; programming code, executable by theprocessor, for providing simultaneous access to questions of theselected two or more relevant triage categories through a computerscreen layout; and programming code, executable by the processor, forproviding triage to the person remotely, away from a treatment centerand without need of medical personnel, through a form of remotecommunication, wherein providing triage comprises: (a) identifying fromall of the selected relevant triage categories a highest urgency tierthat has at least one unasked question; (b) asking the person one of theat least one unasked question of the highest urgency tier; (c) receivinga response from the person to the at least one unasked question; and (d)repeating (a) through (d) for all of the selected triage categoriesuntil the triage disposition is determined.
 46. The system of claim 45,wherein the relevant triage categories are selected before (a) isperformed as executed by the programming code.
 47. The system of claim45, wherein the relevant triage categories are selected at differenttimes as executed by the programming code.
 48. The system of claim 47,wherein (a) and (b) have been performed at least once before selecting asecond relevant triage category as executed by the programming code.